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  • Title: Antidepressant use in late gestation and risk of postpartum haemorrhage: a retrospective cohort study.
    Author: Grzeskowiak LE, McBain R, Dekker GA, Clifton VL.
    Journal: BJOG; 2016 Nov; 123(12):1929-1936. PubMed ID: 26374444.
    Abstract:
    OBJECTIVE: To investigate the association between antidepressant use in late gestation and postpartum haemorrhage (PPH). DESIGN: Retrospective cohort study. SETTING: Tertiary teaching hospital in Adelaide, Australia. POPULATION: A total of 30 198 women delivering between 2002 and 2008. METHODS: Relative risks adjusted for maternal sociodemographics and comorbidities (aRRs) were calculated for PPH, comparing women with late-gestation exposure to antidepressants (n = 558), women with a psychiatric illness but no antidepressant use (n = 1292), and women with neither antenatal exposures (n = 28 348). Additional sensitivity analyses were undertaken, examining associations with severe PPH and postpartum anaemia. MAIN OUTCOME MEASURES: The primary outcome was PPH, defined as a recorded blood loss of ≥500 mL for vaginal deliveries and ≥1000 mL for caesarean sections. Secondary outcomes included severe PPH (≥1000 mL blood loss, irrespective of method of delivery), and the presence of postpartum anaemia (identified from hospital medical records). RESULTS: Compared with unexposed controls, women exposed to antidepressants had an increased risk of PPH (aRR 1.53; 95% confidence interval, 95% CI 1.25-1.86), whereas no increased risk was observed for women with a psychiatric illness but no antidepressant use (aRR 1.04; 95% CI 0.89-1.23). In sensitivity analyses, late gestation antidepressant exposure was associated with an increased risk of severe PPH (aRR 1.84; 95% CI 1.39-2.44), as well as postpartum anaemia (aRR 1.80; 95% CI 1.46-2.22). CONCLUSIONS: Exposure to antidepressants in late gestation was associated with a significantly increased risk of PPH. Although potential confounding by unmeasured factors cannot be ruled out, these findings suggest a direct effect of antidepressant exposure on PPH. TWEETABLE ABSTRACT: Late gestation antidepressant exposure is associated with a significantly increased risk of postpartum haemorrhage.
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